Over the past decade, I've been closely involved in the evolution of clinical summary/transition of care content standards. We started with CDA, then merged the CDA and CCR to create the CCD, which we further constrained with the C32 implementation guide. This year, the Consolidated CDA initiative refined/constrained/optimized the CCD/C32 specifications from IHE, HITSP and HL7 into one easy to use implementation guide.
The only problem with CDA-based standards is that implementation requires expert knowledge of the HL7 Reference Information Model (RIM), a steep learning curve for new developers. Ideally, HL7 and informatics experts would use the RIM or Detailed Clinical Models to develop templates containing easy to read and parse XML that does not require knowledge of the underlying information model.
Green CDA aims to do that - the simplicity of CCR XML tagging with the expandability and modeling of CDA. However, there is a controversy. What do we send on the wire - full CDA or Green CDA?
At the November HIT Standards Committee meeting we endorsed moving forward with GreenCDA as the single over the wire format.
It's likely that existing users of full CDA over the wire will be concerned about the costs and effort required to move to Green CDA on the wire.
Robert Worden, an expert on HL7 mapping tools, wrote a great summary that explains the path forward through the use of transforms:
"There is now tooling which can define a Green CDA and generate 100% reliable transforms to full CDA, all in the same step. That tooling is being used in the UK for the NHS Interoperability Toolkit; and it has been linked to MDHT, so it could be used to Green consolidated CDA and generate the transforms.
Once you have reliable, maintainable transforms, the question “Green CDA or full CDA on the wire?” becomes much less crucial. Any organization, such as ONC, which wishes to endorse Green CDA over the wire (to make life much easier for implementers), can do so, provided they make the transforms readily available. Then, people can use Green CDA over the wire – but anyone who prefers to receive full CDA can always do so, by applying the transform to the Green CDA he receives. RIM experts and non-experts can both be happy.
It is like using banknotes instead of gold for currency, as has been done for several hundred years. Using gold bars for every transaction would be very clumsy, so people used notes which were backed by gold. The bank “promises to pay the bearer on demand” the equivalent in gold. Similarly the Green=>full transform “promises to pay the bearer on demand” a full CDA, if he wants it.
HL7 has now realized that its CDA gold bars are rather clunky, and should encourage the use of banknotes, backed by its RIM-based gold semantics. CDA is the reserve currency, and Green CDAs are the banknotes that people want to use (but counterfeit notes, not backed by the gold transforms, would be worthless!)."
Green CDA over the wire is the right future state. Transforms will help us get there without requiring stakeholders to rip and replace what they have already built.
We have a plan!
Tuesday, November 29, 2011
Monday, November 28, 2011
Ambulatory IT Priorities
The BIDMC Clinical IT Governance Committee was chartered to prioritize project requests and ensure our clinical applications work together as a managed portfolio.
Today we met to discuss ambulatory/outpatient priorities for FY12.
Here's the presentation and the list of ambulatory priorities.
Our top priorities include those workflow enhancements that are necessary to support all the stages of Meaningful Use and emerging healthcare reform requirements.
Key items include many "close the loop initiatives" such as enhancing electronic bidirectional referral communications between primary care givers and specialists.
Also we want to ensure that every diagnostic result - radiology, lab, and pathology/cytology is "signed off" by the ordering clinicians and followup is arranged for any abnormal findings.
Health Information Exchange is always a priority for BIDMC and we continue to be the pilot site for many community efforts which support care coordination, population health and public health.
We're been a leader in e-prescribing and medication management workflow. Electronic pharmacy initiated renewals (rather than calling your physician) for all our patients will be complete in FY12.
We'll continue to implement novel decision support tools so that clinicians are given the right actionable information at the point of care.
We know that population/panel management tools are important to support accountable care organizations and we'll use tools outside of ambulatory systems to produce the necessary reports but make them available inside our ambulatory systems.
Governance is key to demand management and per my recent Thanksgiving post, our governance committees try to complete 80% of the requests we receive. This is not triage, it is stratification. Per the presentation at today's Clinical IT Governance meeting, we'll definitely do our high priorities this year, but lower priorities may or may not be completed based on the unplanned work that arrives, especially "must do" compliance requirements.
Today we met to discuss ambulatory/outpatient priorities for FY12.
Here's the presentation and the list of ambulatory priorities.
Our top priorities include those workflow enhancements that are necessary to support all the stages of Meaningful Use and emerging healthcare reform requirements.
Key items include many "close the loop initiatives" such as enhancing electronic bidirectional referral communications between primary care givers and specialists.
Also we want to ensure that every diagnostic result - radiology, lab, and pathology/cytology is "signed off" by the ordering clinicians and followup is arranged for any abnormal findings.
Health Information Exchange is always a priority for BIDMC and we continue to be the pilot site for many community efforts which support care coordination, population health and public health.
We're been a leader in e-prescribing and medication management workflow. Electronic pharmacy initiated renewals (rather than calling your physician) for all our patients will be complete in FY12.
We'll continue to implement novel decision support tools so that clinicians are given the right actionable information at the point of care.
We know that population/panel management tools are important to support accountable care organizations and we'll use tools outside of ambulatory systems to produce the necessary reports but make them available inside our ambulatory systems.
Governance is key to demand management and per my recent Thanksgiving post, our governance committees try to complete 80% of the requests we receive. This is not triage, it is stratification. Per the presentation at today's Clinical IT Governance meeting, we'll definitely do our high priorities this year, but lower priorities may or may not be completed based on the unplanned work that arrives, especially "must do" compliance requirements.
Thursday, November 24, 2011
There is Hope
Every Thanksgiving I reflect on the state of the world, the state of Healthcare IT, the state of my various roles, my family, and my life.
My message this year - there is hope.
Some may think that the tone of my blog has changed in 2011 - from a focus on cutting edge technology that will revolutionize healthcare to themes of compliance, limited resources, unbridled demand, urgent unplanned projects, and security challenges.
That's a valid observation.
In my 15 years as CIO, I've evolved from creating innovative applications to maintaining customer relationships. I've gone from strategic visionary to resource planner.
This transformation is not about me or my jobs, it's about the world we live in. According to the Center for Health System Change, households with Broadband in the US increased from 47% to 66% from 2007-2010. Smartphones are ubiquitous and the majority of households in the US are IT savvy. That creates a very different expectation for Healthcare IT service delivery.
When I first started as a CIO, mobile devices had not yet been invented, computers were the domain of geeky early adopters, and solutions to problems involved workflow change, not automation.
Today, most of my work is managing demand. I aim to complete 80% of the requests I'm given. I've been told that 50% is typical. Few other industries move so fast and yet have so little tolerance for mistakes.
So, why do I have hope?
I recently met with a Clinical Fellow who is very likely going to be chair of an academic department or a senior hospital administrator some day.
We spoke about the need to understand workflow, the need change behavior, and the critical role of piloting new processes before automating them.
We talked about the need to balance functionality, security, and maintainability. We talked about defining requirements before selecting a solution.
In my blog about Content verses Context, I described the job of the CIO as becoming increasingly impossible because many people expect flying cars when we live in an era of IT bicycles.
However, it is clear that the next generation of leaders, who were born in the 1980's personal computing era, understand that technology is the easy part - policy and process are the hard part.
Also, I have hope because I believe the BIDMC FY12 IT Operating Plan is well aligned with the needs of the business. Today I did a "Venn analysis" of 5 resources
*The BIDMC FY12 IT Operating Plan
*BIDMC FY12 requirements from key customers
*The BIDMC FY12 Annual Operating Plan
*The Meaningful Use Stage 1 and recommended Stage 2 Standards and Certification criteria
*Emerging Compliance projects
I found that the existing BIDMC FY12 IT Operating Plan addresses the needs of all these stakeholders. There are only a few items to defer or reconsider.
Today, the CEO of BIDMC, Kevin Tabb, sent out his Thanksgiving message and highlighted BIDMC Information Systems: "We were named the #1 health care IT organization in the United States for 2011 by Information Week 500, and BIDMC was the first hospital in the country to achieve Meaningful Use of electronic health records, meeting a key set of new federal government standards."
I'll transition my Harvard Medical School CIO role by February 2012. I serve on the search committee, which is following a multi-stakeholder process to find a visionary CIO to lead a great organization.
In my International, National, and State lives, I've worked with incredible people and the trajectory is very good. In 2011, we completed a healthcare IT plan for Japan and for New Zealand. The content, vocabulary, and transport standards for the US are submitted to ONC, completing the foundational work for Meaningful Use Stage 2. The State of Massachusetts has submitted a new State Medicaid Health Plan and completed a new HIT Strategic and Operational plan.
But most importantly, my family life is earning an A.
My daughter has blossomed into a resilient college woman with clear goals, deep friendships, and a very positive self-worth. She's excelling in her coursework, immersing herself in the culture of Tufts University, and traveling to Japan as part of study abroad program this winter. I'm so proud that she has left the nest and is building a life on her own.
My wife and I are planning the next stage of our lives and we'll be in Vermont this weekend visiting farm properties. I'll be 50 this year and although I have many years to go before retirement, it seems the right time to find a property to grow organic vegetables, raise chickens/goats/llamas, and revel in a self sufficient lifestyle, learning to live nearly off grid.
My parents are doing well in a new house and enjoying time with friends, cultural events, and gardening time.
So, there is hope. The world is experiencing a challenging time marked by economic fragility and social unrest. The Occupy movement is raising our consciousness about the disparities in the US. However, it is possible for a strong team of people working hard to excel in healthcare IT. It is possible for your family to thrive based on love, trust, and lifelong learning.
Revel in the next few days of Thanksgiving (we're roasting root vegetables, Brussel spouts and tofu). When you receive your next challenging email or are asked to define a timeline before you understand requirements, scope, or resources, take a breath. There is hope!
My message this year - there is hope.
Some may think that the tone of my blog has changed in 2011 - from a focus on cutting edge technology that will revolutionize healthcare to themes of compliance, limited resources, unbridled demand, urgent unplanned projects, and security challenges.
That's a valid observation.
In my 15 years as CIO, I've evolved from creating innovative applications to maintaining customer relationships. I've gone from strategic visionary to resource planner.
This transformation is not about me or my jobs, it's about the world we live in. According to the Center for Health System Change, households with Broadband in the US increased from 47% to 66% from 2007-2010. Smartphones are ubiquitous and the majority of households in the US are IT savvy. That creates a very different expectation for Healthcare IT service delivery.
When I first started as a CIO, mobile devices had not yet been invented, computers were the domain of geeky early adopters, and solutions to problems involved workflow change, not automation.
Today, most of my work is managing demand. I aim to complete 80% of the requests I'm given. I've been told that 50% is typical. Few other industries move so fast and yet have so little tolerance for mistakes.
So, why do I have hope?
I recently met with a Clinical Fellow who is very likely going to be chair of an academic department or a senior hospital administrator some day.
We spoke about the need to understand workflow, the need change behavior, and the critical role of piloting new processes before automating them.
We talked about the need to balance functionality, security, and maintainability. We talked about defining requirements before selecting a solution.
In my blog about Content verses Context, I described the job of the CIO as becoming increasingly impossible because many people expect flying cars when we live in an era of IT bicycles.
However, it is clear that the next generation of leaders, who were born in the 1980's personal computing era, understand that technology is the easy part - policy and process are the hard part.
Also, I have hope because I believe the BIDMC FY12 IT Operating Plan is well aligned with the needs of the business. Today I did a "Venn analysis" of 5 resources
*The BIDMC FY12 IT Operating Plan
*BIDMC FY12 requirements from key customers
*The BIDMC FY12 Annual Operating Plan
*The Meaningful Use Stage 1 and recommended Stage 2 Standards and Certification criteria
*Emerging Compliance projects
I found that the existing BIDMC FY12 IT Operating Plan addresses the needs of all these stakeholders. There are only a few items to defer or reconsider.
Today, the CEO of BIDMC, Kevin Tabb, sent out his Thanksgiving message and highlighted BIDMC Information Systems: "We were named the #1 health care IT organization in the United States for 2011 by Information Week 500, and BIDMC was the first hospital in the country to achieve Meaningful Use of electronic health records, meeting a key set of new federal government standards."
I'll transition my Harvard Medical School CIO role by February 2012. I serve on the search committee, which is following a multi-stakeholder process to find a visionary CIO to lead a great organization.
In my International, National, and State lives, I've worked with incredible people and the trajectory is very good. In 2011, we completed a healthcare IT plan for Japan and for New Zealand. The content, vocabulary, and transport standards for the US are submitted to ONC, completing the foundational work for Meaningful Use Stage 2. The State of Massachusetts has submitted a new State Medicaid Health Plan and completed a new HIT Strategic and Operational plan.
But most importantly, my family life is earning an A.
My daughter has blossomed into a resilient college woman with clear goals, deep friendships, and a very positive self-worth. She's excelling in her coursework, immersing herself in the culture of Tufts University, and traveling to Japan as part of study abroad program this winter. I'm so proud that she has left the nest and is building a life on her own.
My wife and I are planning the next stage of our lives and we'll be in Vermont this weekend visiting farm properties. I'll be 50 this year and although I have many years to go before retirement, it seems the right time to find a property to grow organic vegetables, raise chickens/goats/llamas, and revel in a self sufficient lifestyle, learning to live nearly off grid.
My parents are doing well in a new house and enjoying time with friends, cultural events, and gardening time.
So, there is hope. The world is experiencing a challenging time marked by economic fragility and social unrest. The Occupy movement is raising our consciousness about the disparities in the US. However, it is possible for a strong team of people working hard to excel in healthcare IT. It is possible for your family to thrive based on love, trust, and lifelong learning.
Revel in the next few days of Thanksgiving (we're roasting root vegetables, Brussel spouts and tofu). When you receive your next challenging email or are asked to define a timeline before you understand requirements, scope, or resources, take a breath. There is hope!
Wednesday, November 23, 2011
More BYOD Worries
I've written about the increasing trend to Bring Your Own Devices (BYOD) to work and the accountability it brings to the CIO.
Every day I receive articles highlighting the increasing risk of mobile devices on the network
The explosion of Android malware
The hacking of Siri
The vulnerabilities of the iPad
It's very clear that in 2012 and beyond we will have to move beyond policy-based controls and we'll have to implement technology based controls that may cost up to $10 per device per month. Given our 1000+ mobile devices, that could be a $150,000/year increased operating expense to protect consumer devices brought from home.
In many ways, 2012 at BIDMC will be the year of increased compliance and we've just named an interim Senior VP of Compliance to build an enterprise-wide compliance team.
CIOs - it's time to tell your CFO to expect an unplanned 6 figure expense to protect your institutional data while at the same time embracing the mobile devices that will enhance productivity and user satisfaction.
Every day I receive articles highlighting the increasing risk of mobile devices on the network
The explosion of Android malware
The hacking of Siri
The vulnerabilities of the iPad
It's very clear that in 2012 and beyond we will have to move beyond policy-based controls and we'll have to implement technology based controls that may cost up to $10 per device per month. Given our 1000+ mobile devices, that could be a $150,000/year increased operating expense to protect consumer devices brought from home.
In many ways, 2012 at BIDMC will be the year of increased compliance and we've just named an interim Senior VP of Compliance to build an enterprise-wide compliance team.
CIOs - it's time to tell your CFO to expect an unplanned 6 figure expense to protect your institutional data while at the same time embracing the mobile devices that will enhance productivity and user satisfaction.
Tuesday, November 22, 2011
The Job of a CIO - Content verses Context
I recently spoke with the CIO of Boston Medical Center, Meg Aranow, who I respect a great deal. We talked about the nature of our jobs, the state of the industry, and the change ahead that is needed to support healthcare reform.
She offered a profound observation - the content of our jobs is great, the context is really challenging.
What does that mean?
Who could ask for better content - cool applications that support live saving medical care and cutting edge research. Innovative healthcare information exchange, patient engagement, and workflow applications. Multi-million dollar infrastructure, great staff, and interesting problems to solve. During my years as an undergraduate, graduate, medical student, and post doc, I dreamt about such content.
However, the context of being a CIO is a struggle. Don't worry, I'm not depressed or pessimistic, just sharing the observations I'm hearing from other healthcare CIOs in 2011.
*You'll create miracles every day (99.99% reliability and great security with a low budget), but you'll not receive credit for everything that works. Instead you'll be held accountable for the .01% that doesn't.
*No matter what your budget, demand will always exceed supply. Success will be finishing half the projects you've been asked to do. You're unlikely to keep a significant percentage of your customers happy.
*You'll be asked to share more data with more trading partners for more purposes, but be held accountable for all privacy breaches, even though you cannot control many of the data flows. Users will demand controls over their devices, bring devices from home, and expect broad freedoms, but you'll be responsible for any security problems they create.
*The pace of consumer IT change - new products and new services arriving every few months - will create expectations for IT service delivery that far exceed the abilities of a thinly staffed IT organization.
*Regulatory burdens will increase exponentially. Compliance is a must do but customers will not appreciate that work. 20% of your budget will be spent on compliance, 20% on security, and 60% on operations. That leaves nothing for innovation (unless its required for compliance or security). Meaningful Use, 5010, ICD-10, new Privacy rules, and healthcare reform will occur simultaneously.
*Every year the amount of infrastructure and applications you support will increase dramatically. However, budgets will increase 2-3% or stay flat. You'll be asked to do more with less. Before long, you'll be asked to do everything for nothing in no time.
*Healthcare organizations in the US are structurally flawed. Hospitals are essentially hotels with operating rooms and patient rooms that are rented by the doctors. Hospitals (other than Kaiser) do not employ the doctors so it's a bit like Toyota owning the factory but allowing the workers to build whatever they want. How about a car with 7 doors and 2 trunks? No problem - do what you want inside the factory. IT will be caught in the middle because hospitals and doctors will want technology solutions that may not be aligned.
*You'll need to constantly change systems while keeping them stable and secure. It will be like changing the wings on a 747 while it's flying.
*Many IT services will not be charged back and the demand for a free service will be infinite. Users will consume whatever computing, storage, and network bandwidth they wish, but you'll be held accountable for provisioning enough to support demand you cannot control.
*Unplanned work will consume 20% of your agenda. Compliance/regulatory change, auditors, and reaccreditation will require urgent redeployment of staff, but you will be held accountable for all the projects that were delayed. You should plan for unplanned work.
Demand management, even with good governance, will be an increasing challenge for CIOs in the future. Here's a bold thought - might the context of being a CIO be nearly impossible in 2012 and beyond, requiring us to rethink the way that IT services are planned and delivered in the future?
As I hear more from my fellow CIOs about compliance burdens, overwhelming demands, and impossible expectations, I will compose another post, speculating about IT organizational models for the future that enable CIOs to improve the context of our work.
She offered a profound observation - the content of our jobs is great, the context is really challenging.
What does that mean?
Who could ask for better content - cool applications that support live saving medical care and cutting edge research. Innovative healthcare information exchange, patient engagement, and workflow applications. Multi-million dollar infrastructure, great staff, and interesting problems to solve. During my years as an undergraduate, graduate, medical student, and post doc, I dreamt about such content.
However, the context of being a CIO is a struggle. Don't worry, I'm not depressed or pessimistic, just sharing the observations I'm hearing from other healthcare CIOs in 2011.
*You'll create miracles every day (99.99% reliability and great security with a low budget), but you'll not receive credit for everything that works. Instead you'll be held accountable for the .01% that doesn't.
*No matter what your budget, demand will always exceed supply. Success will be finishing half the projects you've been asked to do. You're unlikely to keep a significant percentage of your customers happy.
*You'll be asked to share more data with more trading partners for more purposes, but be held accountable for all privacy breaches, even though you cannot control many of the data flows. Users will demand controls over their devices, bring devices from home, and expect broad freedoms, but you'll be responsible for any security problems they create.
*The pace of consumer IT change - new products and new services arriving every few months - will create expectations for IT service delivery that far exceed the abilities of a thinly staffed IT organization.
*Regulatory burdens will increase exponentially. Compliance is a must do but customers will not appreciate that work. 20% of your budget will be spent on compliance, 20% on security, and 60% on operations. That leaves nothing for innovation (unless its required for compliance or security). Meaningful Use, 5010, ICD-10, new Privacy rules, and healthcare reform will occur simultaneously.
*Every year the amount of infrastructure and applications you support will increase dramatically. However, budgets will increase 2-3% or stay flat. You'll be asked to do more with less. Before long, you'll be asked to do everything for nothing in no time.
*Healthcare organizations in the US are structurally flawed. Hospitals are essentially hotels with operating rooms and patient rooms that are rented by the doctors. Hospitals (other than Kaiser) do not employ the doctors so it's a bit like Toyota owning the factory but allowing the workers to build whatever they want. How about a car with 7 doors and 2 trunks? No problem - do what you want inside the factory. IT will be caught in the middle because hospitals and doctors will want technology solutions that may not be aligned.
*You'll need to constantly change systems while keeping them stable and secure. It will be like changing the wings on a 747 while it's flying.
*Many IT services will not be charged back and the demand for a free service will be infinite. Users will consume whatever computing, storage, and network bandwidth they wish, but you'll be held accountable for provisioning enough to support demand you cannot control.
*Unplanned work will consume 20% of your agenda. Compliance/regulatory change, auditors, and reaccreditation will require urgent redeployment of staff, but you will be held accountable for all the projects that were delayed. You should plan for unplanned work.
Demand management, even with good governance, will be an increasing challenge for CIOs in the future. Here's a bold thought - might the context of being a CIO be nearly impossible in 2012 and beyond, requiring us to rethink the way that IT services are planned and delivered in the future?
As I hear more from my fellow CIOs about compliance burdens, overwhelming demands, and impossible expectations, I will compose another post, speculating about IT organizational models for the future that enable CIOs to improve the context of our work.
Monday, November 21, 2011
From Blackberry to iPhone
Last week I retired my Blackberry Bold, removed myself from the Blackberry Enterprise Server, and began using an iPhone 4S as my mobile email, web, and telecommunications platform.
This was not a casual decision. I've used Blackberry products since 1998. The original Blackberry 850 was named one of the top 50 technologies of the past 50 years.
I receive a wireless communication approximately every 30 seconds from 7am-7pm every day. On Tuesdays and Thursdays I receive over 1500 emails per 24 hour period. These communications are filled with media - documents to read, presentations to review, websites to access, and streaming video. Yes, I still use the email triage approach I outlined in 2007 but it's a losing battle. The volume of communication exceeds my ability to process and respond to the information. I could cancel all my meetings, phone calls, and presentations but still fill the entire day with email communication.
I'm not suggesting this is healthy or sane, but it is the reality of communications today.
The iPhone 4S gives me a touch screen user interface to scroll, zoom, and manage my incoming messages. I can view every document, website, and video over 3G networks. Siri and voice recognition features enable me to manage my email by voice. I find myself dictating responses to about a quarter of my email with amazing accuracy.
I'm still in the learning stage, so my ability to type on a touch screen is still not quite as nimble as on the Blackberry keyboard. It's also harder to type while walking between meetings. However, the learning curve is fast, and the toolset provided by the 4S includes much better web browsing and Exchange integration than Blackberry. My Macbook Air running Mac OS X Lion with Apple Mail/iCal/Address book is essentially the same software as on the iPhone 4S, so I can switch seamlessly from my mobile device to my laptop with perfect data synchronization.
RIM has been an innovator. The Blackberry is secure. The Blackberry has been easy to manage at the enterprise level. However, Blackberry is architected to route messages via RIM's centralized infrastructure. If that fails, every Blackberry in the world fails. Blackberry's user experience has not kept pace with the competition. Blackberry's application development tools and app store have not kept pace with iPhone or Android. Devices such as the Playbook have been introduced before they were ready.
All companies regress to the mean and for RIM it appears to be the beginning of the end. In the past year, its stock has declined from 70 to 20, a loss of 70%.
The pace of technology change is accelerating so fast, that even those of us in the industry can hardly keep up. The consumer device world is a shark tank. Competition is fierce and devices come and go as fast as hemline heights and tie widths change.
My switch to an iPhone 4S was predicated on a need to communicate with more flexibility, power, and speed than a Blackberry could support.
I'm not the only one. Per our email administrator:
"I'm seeing a slow death of Blackberry. We have about 400 people still on the Blackberry Enterprise Server. I imagine as contracts expire more will jump to iPhones and Androids. We lose 5-10 Blackberry accounts per month. iPhones currently outnumber Blackberry 3 to 1"
Thus, you'll likely be receiving iPhone 4S emails from me, generated via voice recognition. Apologies for the typos, I'm still learning.
This was not a casual decision. I've used Blackberry products since 1998. The original Blackberry 850 was named one of the top 50 technologies of the past 50 years.
I receive a wireless communication approximately every 30 seconds from 7am-7pm every day. On Tuesdays and Thursdays I receive over 1500 emails per 24 hour period. These communications are filled with media - documents to read, presentations to review, websites to access, and streaming video. Yes, I still use the email triage approach I outlined in 2007 but it's a losing battle. The volume of communication exceeds my ability to process and respond to the information. I could cancel all my meetings, phone calls, and presentations but still fill the entire day with email communication.
I'm not suggesting this is healthy or sane, but it is the reality of communications today.
The iPhone 4S gives me a touch screen user interface to scroll, zoom, and manage my incoming messages. I can view every document, website, and video over 3G networks. Siri and voice recognition features enable me to manage my email by voice. I find myself dictating responses to about a quarter of my email with amazing accuracy.
I'm still in the learning stage, so my ability to type on a touch screen is still not quite as nimble as on the Blackberry keyboard. It's also harder to type while walking between meetings. However, the learning curve is fast, and the toolset provided by the 4S includes much better web browsing and Exchange integration than Blackberry. My Macbook Air running Mac OS X Lion with Apple Mail/iCal/Address book is essentially the same software as on the iPhone 4S, so I can switch seamlessly from my mobile device to my laptop with perfect data synchronization.
RIM has been an innovator. The Blackberry is secure. The Blackberry has been easy to manage at the enterprise level. However, Blackberry is architected to route messages via RIM's centralized infrastructure. If that fails, every Blackberry in the world fails. Blackberry's user experience has not kept pace with the competition. Blackberry's application development tools and app store have not kept pace with iPhone or Android. Devices such as the Playbook have been introduced before they were ready.
All companies regress to the mean and for RIM it appears to be the beginning of the end. In the past year, its stock has declined from 70 to 20, a loss of 70%.
The pace of technology change is accelerating so fast, that even those of us in the industry can hardly keep up. The consumer device world is a shark tank. Competition is fierce and devices come and go as fast as hemline heights and tie widths change.
My switch to an iPhone 4S was predicated on a need to communicate with more flexibility, power, and speed than a Blackberry could support.
I'm not the only one. Per our email administrator:
"I'm seeing a slow death of Blackberry. We have about 400 people still on the Blackberry Enterprise Server. I imagine as contracts expire more will jump to iPhones and Androids. We lose 5-10 Blackberry accounts per month. iPhones currently outnumber Blackberry 3 to 1"
Thus, you'll likely be receiving iPhone 4S emails from me, generated via voice recognition. Apologies for the typos, I'm still learning.
Friday, November 18, 2011
Cool Technology of the Week
This week, I was asked to evaluate a longstanding slow website problem.
One of the most challenging questions that CIOs receive is the "application is slow, can you fix it?" problem.
Root causes range from underpowered laptops, virus infected desktops, slow wireless connections, firewall congestion, web server memory leaks, storage I/O bottlenecks, database indexing, and poorly written HTML.
For this particular issue, I suspected application issues in the use of Javascript, style sheets, graphics, and flash objects, not infrastructure.
A quick search on Google yielded this great website optimization tool , which is a companion to an O'Reilly book Website Optimization: Speed, Search Engine & Conversion Rate Secrets by Andrew B. King.
It diagnosed the problem immediately as an inefficient web page design. We implemented compression of stylesheets, Javascript, and images, which increased performance ten-fold. The entire site is being rewritten and we'll be sure to use this tool before go live to verify that we've followed best practices.
A great tool and an O'Reilly Book for optimizing website performance - that's cool!
One of the most challenging questions that CIOs receive is the "application is slow, can you fix it?" problem.
Root causes range from underpowered laptops, virus infected desktops, slow wireless connections, firewall congestion, web server memory leaks, storage I/O bottlenecks, database indexing, and poorly written HTML.
For this particular issue, I suspected application issues in the use of Javascript, style sheets, graphics, and flash objects, not infrastructure.
A quick search on Google yielded this great website optimization tool , which is a companion to an O'Reilly book Website Optimization: Speed, Search Engine & Conversion Rate Secrets by Andrew B. King.
It diagnosed the problem immediately as an inefficient web page design. We implemented compression of stylesheets, Javascript, and images, which increased performance ten-fold. The entire site is being rewritten and we'll be sure to use this tool before go live to verify that we've followed best practices.
A great tool and an O'Reilly Book for optimizing website performance - that's cool!
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